Water Damage Paperwork

Water Damage Worksheet (first section office use)

Name: _____________________________ Date: __________________ Day of Week: ___________
Job Address: ________________________ Time of Call: ___________ Contact:________________
E-mail: ____________________________ Home Phone: ___________ Contact #: ______________
Billing Address: _____________________ Husb. work: ____________ Husb. Cell: ______________ T?
___________________________________ Wife work: ____________ Wife Cell: ______________ T?
Insurance Co: ______________________ Agent: _________________ Phone: _______________
Insurance Adjuster: __________________ Phone: _______________ Cell: ____________________
Floor Underneath: Concrete Particle Board Red-X Plywood Hardwood T&G Other
Is this a “5th Generation” carpet? Yes  No  Clean  Sewer  How long wet?____________
Type of Carpet: glued down  stretched in  Power: On  Off  Heat: On  Off 
What happened?________________________________________________________________________
_____________________________________________________________________________________
Directions to home: _____________________________________________________________________

On-site Initial Interview/Inspection

Introduction- Full name, company, reason you are there. (Call customer by last name.) Customer Interview:
1. “Have you identified where the water came from?___________________________________________
2. “Are there any unsafe conditions that you know of?”_________________________________________
a. Electrical items/plugs wet? Where are the breakers?”__________________________________
b. “Sagging ceilings due to water?” _________________________________________________
3. “Can you show me the source of the water? ________________________________________________
4. “Has the in-flow been stopped?” _________________________________________________________
5. “Does anyone in the family have any unusual health issues”? __________________________________
6. “Do you have any special concerns/ items of unusual value or sentimental appeal?” (List items/ areas out for
Special Handling. Don’t forget Indirect Verbal Reassurance.)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
7. “Please give me a tour of the affected areas and as we go please share any questions that you have. I’ll also
be checking areas that may not appear to be wet for any hidden water intrusion. Is it OK if _______ starts
setting up our hoses and equipment?” (Ask permission before opening any closed doors, cabinets, furn, etc.)
Loss Review/Damage Containment Planning
1. “Let me review your concerns and questions …”
2. “Here is what I will be doing right now as part of what we call Damage Containment. (Itemize the steps
you will be doing today and the equipment you will place along with your estimated time for drying.) This
step will dry and stabilize the home and prevent further damage. This first step will also allow you time to
coordinate between your insurance company and our office.”
3. “If I can get you to sign here authorizing us to start work we’ll get started ….” (Work Authorization)

© Copyright 2004 Jon-Don (800)-556-6366

400 Medinah Road Roselle, IL 60172 Water Damage/ Paperwork- 1a
 Water Damage Paperwork
On-site Internal Paperwork

Crew Chief: ________________________ Arrival Time:_____________________________________

Assistant: __________________________ Departure Time: __________________________________
Authorization Signed? Yes  No  Cover letter left? Yes  No  Initial W/D Estimate left?
Moisture Control Monitoring Sheet left: Monitoring frequency: __________________________

Name of room (ck if gluedown.) Size of room (l X w) Area pulled Extract only

____________________________ ___________________ _____________ ________________

____________________________ ___________________ _____________ ________________

____________________________ ___________________ _____________ ________________

____________________________ ___________________ _____________ ________________

____________________________ ___________________ _____________ ________________

____________________________ ___________________ _____________ ________________

Can we reinstall? Yes  No  Equip. needed: ________________________ Type of pad: ___________

Tack strip OK? Yes  No  Metal OK? Yes  No  If not what type & how much: ______________
Molding pulled? Yes  No  Where & how much? _________________________________________
Quality of original installation: ______________________ Condition of subfloor:__________________
Backing: Primary ________________ Secondary ________________ Condition ______________________
Carpet type: ____________________ Condition: ________________ Latex OK? Yes  No 
Any seams torn & where? ________________________________ # of seams cut: _____________________
Where seams cut? __________________________________________________________________________
# of doors pulled: _____ # of airmovers: _____ # of dehumidifiers: _____ Type: ________ # of stands: _____
Furniture moving time: ____________________ Stain removal: _____________________________________
Is a follow up inspection needed? Yes  No  If yes, why? _____________________________________

Job Notes:_________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________
Keep the customer involved- If the home owner is interested always explain what you are doing and the
purpose of each piece of equipment. Keep technical jargon to a minimum and use simple illustrations. Display
a “Sense of Urgency” and avoid personal chit-chat.
Post Inspection- As you are finishing up the initial work simply say, “Let me review with you what we’ve
done…” Show the home owner around and explain your internal paperwork including our Moisture Control
Monitoring Sheet. So what is going to happen next? “Here is the next step in the process…” Give the client a
reasonable time line and what their responsibilities are, including contacting their insurance company. Be sure to
double check their contact phone numbers and how we will access their home.
Thank you and good-bye- “Mrs. Jones, I’ve enjoyed meeting you even under these ‘unhappy circumstances’!
If you have any questions just call me. Do you still have my card? Here, let me write my cell phone number on
the back. We really appreciate your business and IF you are happy with our work please tell your insurance
agent and adjuster that we did a good job!”

© Copyright 2004 Jon-Don (800)-556-6366

400 Medinah Road Roselle, IL 60172 Water Damage/ Paperwork- 1b
 Water Damage Paperwork

Date:__________
Name:_____________________________
Address____________________________
___________________________________
Initial Water "Damage Containment Phase" Estimate
Damage Containment Estimate Only: Regular Rates (Overtime charges addnl.)
Unit prices Min. Chg. Total
Initial Call and water extraction _____ sq. ft. @ .40 up 120.00 ______
Disengage carpet and remove pad _____ sq. ft. @ .32 85.00 ______
Disinfect subfloor & carpet back _____ sq. ft. @ .18 50.00 ______
Door removal and labeling _____ doors @ 6.00 ______
Furniture and contents moving _____ hours @ 48.00 ______
____ Axial fans _____ days @ 30.00 60.00 ______
____ Small dehumidifiers _____ days @ 55.00 110.00 ______
____ Large dehumidifiers _____ days @ 72.00 144.00 ______
____ X-Large dehumidifiers _____ days @105.00 210.00 ______
Round trip mileage _____ miles @ .40 ______
Travel time (outside 20 mile radius) _____ hours @ 40.00 ______
Overtime Surcharges (see below) ______
Preliminary total for Initial Damage Containment Phase only- _________

Dear Homeowner,

This estimate is only for the initial damage control work we will be doing on this water damage
service call and the rental charge for the drying equipment we recommend leaving. Prices and the
scope of repairs are subject to change if further damage is discovered. THE CHARGES LISTED ARE
ONLY FOR THE SERVICES NECESSARY TO STABILIZE YOUR HOME AND HELP PREVENT
FURTHER DAMAGE.
If you decide to restore your carpeting, etc. further work and charges will be necessary. We will be
happy to furnish a complete restoration price for both you and your insurance company after your home
is completely dried out.
Overtime surcharges: Many water damages require immediate response to prevent further damage.
Overtime surcharges are based on the labor part of the estimate only, not the equipment rentals.

Weekdays: 5:00 PM - 12:00 Midnight additional 50%

Week nights: 12:00 Midnight to 8:00 AM additional 80%
Weekends: 5:00 PM Friday to 8:00 AM Mon. additional 80%

I have received a copy of this initial damage containment phase and understand it is covered by the
terms of the Work Authorization I have signed.

Signed __________________________________ Date ____________________

© Copyright 2004 Jon-Don (800)-556-6366

400 Medinah Road Roselle, IL 60172 Water Damage/ Paperwork- 2
 Water Damage Paperwork

Date of Mailing ____________

Name
Address
City, State Zip

Dear _____________,

Enclosed is the paperwork for your recent loss. Because so many people have never been
involved in this type of situation, I would like to review the remaining few steps to be followed:

1. You will receive this packet only after we have completed the restoration of your home.

2. If appropriate, we will have delivered a copy of the enclosed report to your insurance agent and/or
your adjustor to help expedite payment to you.

3. Our terms are net 30 days from the date we sent you your final statement. I need to emphasize that
Our Company is working for you, not your insurance company, and payment will usually be
made directly to you. Payment to Our Company, in turn, needs to be made by you to us.

4. Per our authorization contract with you, if we have not received payment within 30 days of the data
on this letter, we will send you a statement which will include interest charges. To avoid these late
charges, we suggest that you immediately contact your insurance agent or adjustor to see if
additional paperwork is required from you to process your claim. Our Company has no influence
with your insurance company - you have a great deal of influence.

This letter is meant to provide a smooth transition between the expert care we have been giving your
home and the final paperwork. While we understand a damaged home is never “fun,” I hope that Our
Company has given you superb service through this difficult time.

Please take a few moments to fill out the enclosed Customer Comment form. We appreciate your input
and we do listen to our clients. Also, if you have any questions, please feel free to call me here at the
office.

Sincerely,

© Copyright 2004 Jon-Don (800)-556-6366

400 Medinah Road Roselle, IL 60172 Water Damage/ Paperwork- 3